Key takeaway
A large 2023 head-to-head trial compared IV ketamine with electroconvulsive therapy for people with treatment-resistant depression.
The question Electroconvulsive therapy (ECT) has long been considered one of the most effective options for severe, treatment-resistant depression. The ELEKT-D trial, published in the New England Journal of Medicine in 2023, asked whether IV ketamine could perform as well.
What researchers did About 400 adults with treatment-resistant major depression (without psychosis) were randomly assigned to either IV ketamine twice weekly or ECT three times weekly over three weeks.
What they found - Ketamine was non-inferior to ECT: roughly 55% of ketamine patients responded, compared with about 41% in the ECT group. - ECT was associated with more short-term memory complaints; ketamine more often caused temporary dissociation during infusions. - Benefits in both groups were generally maintained during a six-month follow-up for people who responded.
What it means for patients For many outpatients with treatment-resistant depression, ketamine may be a reasonable alternative to discuss with a provider before or instead of ECT. ECT remains important, particularly for severe or psychotic depression.
Source: Anand A, et al. N Engl J Med. 2023;388:2315-2325. This summary is educational and not medical advice.
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